Healthcare Provider Details

I. General information

NPI: 1376671800
Provider Name (Legal Business Name): GALLATIN CTY SCHOOL HEALTH CTR NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 HIGHWAY 13
JUNCTION IL
62954-2118
US

IV. Provider business mailing address

5150 HIGHWAY 13
JUNCTION IL
62954-2118
US

V. Phone/Fax

Practice location:
  • Phone: 618-272-7132
  • Fax: 618-272-7064
Mailing address:
  • Phone: 618-272-7132
  • Fax: 618-272-7064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ANGIE HAMPTON
Title or Position: CEO
Credential:
Phone: 618-273-3326